Comparative evaluation of oral premedication with clonidine and metoprolol on surgical field conditions and intraoperative hemodynamics during functional endoscopic sinus surgery

Abstract

Background and aims: Bloodless surgical field during functional endoscopic sinus surgery (FESS) is an essential part, and research continues to find simple and effective regime for it. This study was aimed to compare the efficacy of oral clonidine versus oral metoprolol as premedicants regarding surgical field condition and controlled hypotension in patients undergoing FESS.

Material and methods: Sixty-eight patients of American Society of Anesthesiologists (ASA) physical status (PS) I and II aged 18-60 years, of both genders, scheduled for FESS under general anesthesia were randomly allocated in two groups. Group C (n = 34) received oral clonidine 300 μg and group M (n = 34) received oral metoprolol 50 mg, 2 h before surgery. Controlled hypotension (mean arterial pressure [MAP] 65-75 mmHg) was achieved by titrating sevoflurane (1%-3%). Primary outcome measured was surgical field visualization by Average Category Scale (ACS 0-5), and the secondary outcomes measured were hemodynamic parameters, sevoflurane requirement, recovery, and side effects. Categorical, continuous, and ordinal data were compared using Chi-square test, t-test, and Mann-Whitney test, respectively. P < 0.05 was considered as statistically significant.

Results: ACS was significantly less in group C compared to group M up to 60 min, (P < 0.05). Mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP were significantly less in group C compared to group M at all time intervals (P < 0.05) Intraoperative sevoflurane requirement (vol %) was significantly less in group C (1.21 ± 0.42) compared to group M (1.68 ± 0.53) (P = 0.000).

Conclusions: Premedication with oral clonidine was found to be superior to oral metoprolol as it provided significantly better surgical field condition during FESS with much efficient controlled hypotension and anesthetic-sparing effect.Standardized Study Reporting Requirements: CONSORT: http://www.consort-statement.org/.

Keywords: Clonidine; Key Message:; Premedication with oral clonidine 300 µg is better than oral metoprolol 50 mg for providing improved surgical field visualization during FESS with much efficient controlled hypotension and anesthetic-sparing effect.; controlled hypotension; metoprolol; oral; premedication.